Why compensation claims are rejected - and what you can do about it

Why compensation claims are rejected - and what you can do about it

Most people assume that if they hurt themselves at work, they will be covered by WorkCover insurance.

Whilst sometimes claims can be relatively straight forward, it can be a rude shock when the insurer rejects a claim under WorkCover and the injured person is left without payment for the medical expenses and time off work.

There are a number of reasons why a claim might be rejected. There may be medical disputes or factual disputes that need to be challenged.

Some of the most common reasons for rejection include that:

  1. The insurer deems the injury did not occur in the course of employment;
  2. The insurer deems a pre-existing medical condition is the cause of the worker's ongoing problems;
  3. The worker did not report the injury in a timely fashion;
  4. The worker was injured as a result of reasonable management action and is therefore excluded from claiming compensation in accordance with law. This is a standard reason for rejection for claims dealing with psychological injury.

What do I do if my claim has been rejected?

If a claim is rejected, the first step is to go to conciliation. It is important that you lodge a request for conciliation within 60 days of a decision being made.

During that time, depending on what the reason for the rejection is, it is important to obtain information in support of your claim. Often medical practitioners including your own, will be asked to provide their opinion as to the connection between your work duties and your injury. This material is really helpful at conciliation and providing this information can lead to quicker resolution. You may also need it to challenge an opinion provided by the insurer's doctor.

If the issue relates to when you reported the injury, material from your doctor close to the time you hurt yourself (even if you didn't report it to work), can help deal with this issue.

It is also important to get legal advice quickly. At Adviceline Injury Lawyers, we can assist in explaining the conciliation process, arrange for someone to assist you and provide advice as to possible outcomes.

If your claim is accepted, we can then give you advice about other entitlement you might have. If conciliation is not successful in resolving the issues, you then need legal advice about challenging this in Court.

If your claim has been rejected, you need expert advice. We are here to help. Contact Adviceline Injury Lawyers on (03) 9321 9988.

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